Incidence, outcomes, and risk of surgical failure after development of early hypotony following Aurolab aqueous drainage implant surgery

Purpose: To report the incidence, outcomes, and risk of surgical failure after early postoperative hypotony following Aurolab Aqueous Drainage Implant (AADI) surgery for adult and pediatric refractory glaucoma. Methods: Medical records of patients who underwent AADI between January 2013 and March 2017 with a minimum of 2?years follow?up were retrospectively reviewed. Early postoperative hypotony was defined as IOP ?5 mmHg within the first 3 months after AADI. Surgical failure of AADI was defined as IOP >21 mmHg or reduced <20% below baseline on two consecutive follow?up visits after 3 months, IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Results: Early postoperative hypotony was seen in 15/213 eyes (7%) in the adult group and in 6/101 eyes (6%) in the pediatric group. The onset of hypotony was significantly earlier in the pediatric group (median = 39 days post AADI, IQR = 20–58 days) compared with adult eyes (median = 51 days post AADI, IQR = 30–72 days) (P = 0.02). Eyes with early postoperative hypotony did not have an increased risk of cumulative surgical failure as compared with eyes without hypotony in both adult (33.3% vs. 23.7%; P = 0.48) and pediatric (33.3% vs. 13.7%; P = 0.16) refractory glaucoma. All eyes recovered from hypotony, though one adult eye developed retinal detachment and one pediatric eye developed corneal decompensation and lost vision. Conclusion: Early postoperative hypotony was an infrequent complication post AADI and occurred earlier in pediatric eyes. Early postoperative hypotony did not increase risk of surgical failure up to 2 years.

Bilateral Iridocorneal Endothelial Syndrome

Objectives@#We presented a case of bilateral iridocorneal endothelial (ICE) syndrome with secondary glaucoma and discussed its clinical presentation and management.@*Study design@#This is a case report.@*Results@#A 12-year old female consulted for a one-year history of progressive blurring of vision in both eyes associated with abnormal pupils and occasional eye pain. Polycoria, shallow anterior chambers, increased intraocular pressures (IOP), areas of closed angles on gonioscopy, and increased cup-to-disc ratio in both eyes indicative of ICE syndrome were present. Management included anti-glaucoma medications and implantation of glaucoma drainage devices (GDD).@*Conclusion@#Early detection with regular follow-ups leading to prompt management of the ICE syndrome are necessary. IOP control may be challenging due to the nature of the disease and may require multiple surgeries including GDD implantation to achieve successful outcomes. Early use of GDD may be beneficial for pediatric patients with ICE and glaucoma, and may require additional surgeries to adequately manage the IOP.

Outcomes of rhegmatogenous retinal detachment surgery in eyes with pre-existing glaucoma drainage devices

Purpose: To evaluate the outcome of rhegmatogenous retinal detachment (RRD) surgery in eyes with preplaced glaucoma drainage device (GDD) with respect to intraocular pressure (IOP) control as well as success of retinal detachment (RD) surgery. Methods: It is a retrospective case series. The case records of patients who underwent RD surgery after GDD implantation from 2000 to 2014 were screened. The demographic data, ocular examination findings at all visits, details pertaining to retinal detachment and its repair, and the postoperative course was documented. Results: Twelve patients were included in study. The mean age of patients was 24.3 years (median 11 years; range 3-72 years). Male: Female ratio was 3:1. Mean duration between GDD and RD was 24 months (4 days-91 months). Of the ten eyes that underwent surgery, nine eyes underwent pars plana vitrectomy, and in one eye scleral buckling was done. GDD was removed only in one eye. At final follow-up, retina was attached with controlled IOP in 6 (60%) eyes, of which 5 (50%) had improvement in best corrected visual acuity. Conclusion: Pars plana vitrectomy was required in almost all cases for the management of RD in eyes with preplaced GDD. Retinal reattachment with good IOP control could be achieved in 60% of eyes. Removal of the drainage device was not essential for the effective management of the RRD in most cases. With multidisciplinary approach, close follow-up and timely intervention, vision can be preserved along with glaucoma control and successful retinal reattachment.

Beneficios y riesgos de dispositivos de drenaje para tratamiento de glaucoma / Benefits and risks of glaucoma drainage devices for glaucoma treatment

En el tratamiento del glaucoma se suele iniciar con medicamentos. En segunda instancia, se recurre a cirugías o implante de dispositivos de drenaje. Los dispositivos de drenaje son usados para tratar glaucomas refractarios (no responden a tratamiento médico o cirugías), cuando la trabeculectomía o cualquier cirugía falla en el control de la presión intraocular. En la actualidad existe una gama de diseños que básicamente consisten en un tubo que drena humor acuoso desde la cámara anterior o posterior a un plato ubicado en la zona ecuatorial del ojo. Asimismo, los dispositivos de drenaje han tenido un avance significativo en los últimos años, y han variado el mecanismo de acción, los materiales, las dimensiones y las indicaciones de uso. Este trabajo proporciona información sobre el estado del arte del glaucoma, así como una revisión sistemática de la literatura sobre los dispositivos de drenaje, que describe su mecanismo de funcionamiento, las principales ventajas, la efectividad medida según la variación de la presión intraocular y las complicaciones más importantes halladas en cada estudio(AU)

The glaucoma treatment may be started with drugs, followed by surgeries or implantation of drainage devices. Drainage devices are used to treat refractory glaucomas (they do not respond to medical treatment or surgeries) when trabeculectomy fails to control intraocular pressure. There is a range of designs that basically consist of a tube that drains aqueous humor from the anterior or posterior chamber to a plate located in the equatorial area of the eye. Likewise, drainage devices have made significant progress in recent years, varying the mechanism of action, materials, dimensions and indications of use. This paper provides information on the state of the art of glaucoma, as well as a systematic literature review on the main drainage devices, describing its mechanism of operation, main advantages, effectiveness measured according to the variation of intraocular pressure and the most important complications found in each study(AU)

A new futuristic glaucoma therapeutic management paradigm.

Glaucoma is a group of diseases, characterized by a progressive form of optic nerve damage. Current studies indicate more selective pathophysiological involvement, thereby targeted therapies are warranted. Although both the prostaglandin analogs and beta blockers are still, most commonly used drugs for glaucoma, due to their effi cacy, lack of adverse effects. In addition, a stepped care approach is the corner stone for its management. In addition, attempts have been made to enhance patient compliance and ocular delivery of already available anti-glaucoma drugs such as pilocarpine and timolol maleate. Notable among futuristic treatment options are; novel delivery systems, benzalkonium chloride-free drugs, various glaucoma drainage devices, new targeted therapies and prompt diagnosis plus aggressive treatment, in patients with primary angle closure glaucoma. Promising new focus on vision sparing, greater patient safety and tolerability will provide improved treatment options and long-term preservation of vision and quality of life.

Effects of intraocular pressure drop for two kinds of aqueous humor drainage implant devices / 医用生物力学

Objective To observe and compare the effects of intraocular pressure (IOP) drop on using two kinds of aqueous drainage device implantation. Methods Forty healthy New Zealand white rabbits were chosen for the experiments. According to different implant devices, they were divided into NADI (new aqueous drainage implant) group and Ahmed group respectively, with 20 rabbits in each. Results Neither group appeared shallow anterior chamber after operation. At 8th week after operation, the postoperative IOP of NADI group and Ahmed group was decreased by 19.4% and 15.7%, respectively, as compared to the preoperative IOP. Statistical comparison showed that there were significant differences in IOP between two groups within 8 weeks (P＜0.05), and the IOP of NADI group was decreased more significantly than that of Ahmed group. Conclusions The IOP in NADI group was reduced more than that in Ahmed group, and such IOP drop was maintained for a longer period in NADI group, which means that NADI has an obvious IOP drop effect and good prospect in clinical application.

Surgical management of glaucoma: Evolving paradigms.

Surgical intervention is mandatory in the case of documentation of the progression of glaucomatous optic neuropathy despite the administration of maximal tolerated medical therapy, and in cases where compliance is poor. Minimal complications, good long-term intraocular pressure (IOP) control, and precisely titrated target IOPs resulting in avoidance of visual impairment are the primary goals of surgical intervention. This article is an attempt to provide a broad overview of the therapeutic options available to the glaucoma surgeon. The available surgical modalities have undergone modifications and refinements over time, with a view to improve patient outcomes and visual recovery, yet are fraught with intra- and postoperative complications. The risk and benefits of each of the available surgical options must be critically evaluated and customized to fit the needs of the particular patient. There is insufficient evidence at present to establish the superiority of any of these surgeries over the other.

Surgical management of glaucoma: An Indian perspective.

Glaucoma is a serious sight-threatening disorder aptly named the Silent thief of sight. India, being the second most populous country in the world, has about 20% of the world glaucoma population. The complex geographical and socioeconomic architecture and the economic extremes have a profound effect on its health system. The present times are abundant with fresh developments in the field of glaucoma. Though newer modalities are present in India, they are not ample and are unequally distributed. Adherence and persistence with medical therapy is an issue owing to a multitude of factors. In such a setting, most of the ophthalmologists find themselves performing glaucoma surgeries quite often. In the present era, there are a number of new surgeries to choose from, especially procedures which are nonpenetrating and blebless. Faced with a spectrum of surgeries from shunts to canal surgeries and trabecular bypass devices, the surgeon is often in a dilemma. Still, trabeculectomy remains the gold standard with an increasing trend toward glaucoma drainage devices. The new procedures and devices are worth exploring but await long-term results, good training of surgeons and cost effectiveness.